Gynecology Xagena

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Patients with BRCA1 and BRCA2 mutations: contralateral mastectomy and survival after breast cancer

A retrospective study has compared the survival rates of women with BRCA associated breast cancer who did and did not undergo mastectomy of the contralateral breast.

A total of 390 women with a family history of stage I or II breast cancer who were carriers of BRCA1 and BRCA2 mutations and initially treated with unilateral or bilateral mastectomy. 181 patients had mastectomy of the contralateral breast.
Patients were followed for up to 20 years from diagnosis.

The main outcome measure was death from breast cancer.

79 women died of breast cancer in the follow-up period ( 18 in the bilateral mastectomy group and 61 in the unilateral mastectomy group ).

The median follow-up time was 14.3 years ( range 0.1-20.0 years ).

At 20 years the survival rate for women who had mastectomy of the contralateral breast was 88% ( 95% confidence interval 83% to 93% ) and for those who did not was 66% ( 59% to 73% ).

In a multivariable analysis, controlling for age at diagnosis, year of diagnosis, treatment, and other prognostic features, contralateral mastectomy was associated with a 48% reduction in death from breast cancer ( hazard ratio, HR=0.52, 95% confidence interval 0.29 to 0.93; P=0.03 ).

In a propensity score adjusted analysis of 79 matched pairs, the association was not significant ( 0.60, 0.34 to 1.06; P=0.08 ).

Based on these results, researchers predict that of 100 women treated with contralateral mastectomy, 87 will be alive at 20 years compared with 66 of 100 women treated with unilateral mastectomy.

In conclusion, the study suggests that women who are positive for BRCA mutations and who are treated for stage I or II breast cancer with bilateral mastectomy are less likely to die from breast cancer than women who are treated with unilateral mastectomy.
Given the small number of events in this cohort, further research is required to confirm these findings. ( Xagena )

Metcalfe K et al, BMJ 2014;348:g226